Whiplash severity. Whiplash Injury: Causes, Symptoms, and Treatment Options
What are the common causes of whiplash. How is whiplash diagnosed. What are the most effective treatment options for whiplash. Can whiplash lead to chronic pain. How long does it typically take to recover from whiplash.
Understanding Whiplash: A Comprehensive Overview
Whiplash is a complex neck injury that occurs when the head is suddenly and forcefully jerked backward and then forward, or vice versa. This rapid motion can cause damage to the delicate structures of the neck, including muscles, ligaments, nerves, and intervertebral discs. Despite its prevalence, whiplash remains a poorly understood condition that can have significant impacts on a person’s quality of life.
The Mechanics of Whiplash
To truly grasp the nature of whiplash, it’s essential to understand the biomechanics involved. During a whiplash event, the neck undergoes a series of rapid movements:
- Initial backward movement (hyperextension)
- Followed by a forward motion (hyperflexion)
- Potential side-to-side movement (lateral flexion)
These movements occur in a fraction of a second, often faster than the body’s natural protective reflexes can respond. As a result, the soft tissues in the neck are stretched beyond their normal range of motion, leading to strain, sprain, and potential tearing of these structures.
Common Causes of Whiplash Injuries
While most people associate whiplash with car accidents, particularly rear-end collisions, there are several other scenarios that can lead to this type of injury. Understanding these causes can help in prevention and early recognition of symptoms.
Vehicular Accidents
Automobile collisions remain the primary cause of whiplash injuries. In a rear-end collision, the impact propels the vehicle forward, causing the occupant’s head to snap backward and then rapidly forward. Side-impact and front-end collisions can also result in whiplash, though the mechanism of injury may differ slightly.
Sports-Related Injuries
Contact sports such as football, rugby, and boxing pose a significant risk for whiplash. The sudden impacts and tackles involved in these activities can subject the neck to forces similar to those experienced in a car accident. Even non-contact sports like skiing or diving can lead to whiplash if a fall or collision occurs.
Falls and Physical Assaults
Slip and fall accidents, especially those involving a backward fall, can cause the head to snap back violently, resulting in whiplash. Similarly, physical assaults, such as being punched or shaken, can produce the rapid back-and-forth motion characteristic of whiplash injuries.
Amusement Park Rides
The sudden accelerations and decelerations experienced on roller coasters and other high-speed rides can sometimes lead to whiplash-like injuries, particularly in individuals with pre-existing neck conditions.
Recognizing the Symptoms of Whiplash
The symptoms of whiplash can vary widely between individuals and may not always appear immediately after the injury. It’s crucial to be aware of the potential signs to seek timely medical attention.
Physical Symptoms
- Neck pain and stiffness
- Shoulder and upper back pain
- Headaches, often starting at the base of the skull
- Dizziness and balance problems
- Reduced range of motion in the neck
- Arm pain or numbness
- Jaw pain (temporomandibular joint symptoms)
Cognitive and Neurological Symptoms
- Fatigue
- Difficulty concentrating
- Memory problems
- Sleep disturbances
- Blurred vision
- Ringing in the ears (tinnitus)
Psychological Symptoms
- Irritability
- Depression
- Anxiety
Are all whiplash injuries immediately apparent? Not necessarily. In some cases, symptoms may take 24 to 48 hours to develop fully. This delayed onset can be particularly dangerous, as it may lead individuals to underestimate the severity of their injury initially.
Diagnosing Whiplash: A Multi-Faceted Approach
Accurately diagnosing whiplash requires a comprehensive evaluation by a healthcare professional. The diagnostic process typically involves several steps to assess the extent of the injury and rule out other potential conditions.
Medical History and Physical Examination
The first step in diagnosis is a thorough review of the patient’s medical history and the circumstances surrounding the injury. The healthcare provider will ask detailed questions about the incident, symptoms experienced, and any pre-existing neck or back conditions. This is followed by a physical examination to assess:
- Range of motion in the neck and shoulders
- Tenderness or pain in the neck, shoulders, and back
- Reflexes, strength, and sensation in the limbs
- Signs of muscle spasm or injury to the ligaments
Imaging Studies
While soft tissue injuries are not visible on standard X-rays, imaging studies play a crucial role in diagnosing whiplash and ruling out more severe injuries. Common imaging techniques include:
- X-rays: To check for fractures, dislocations, or arthritis
- CT (Computed Tomography) scans: For a more detailed view of the bony structures
- MRI (Magnetic Resonance Imaging): To visualize soft tissues, including muscles, ligaments, and intervertebral discs
Is MRI always necessary for diagnosing whiplash? Not always. MRI is typically reserved for cases where there is suspicion of disc herniation, nerve compression, or other soft tissue injuries not visible on X-rays or CT scans.
Specialized Tests
In some cases, additional tests may be necessary to fully evaluate the extent of the injury and its impact on the patient’s function:
- Electromyography (EMG): To assess nerve function and detect any nerve compression or damage
- Nerve conduction studies: To evaluate the transmission of electrical signals along nerves
- Neuropsychological testing: To assess cognitive function in cases where concentration or memory problems are reported
Treatment Strategies for Whiplash Injuries
The treatment of whiplash is typically tailored to the individual’s specific symptoms and the severity of their injury. The primary goals of treatment are to reduce pain, restore normal range of motion, and prevent chronic complications.
Immediate Care
In the first 24-48 hours following a whiplash injury, the focus is on reducing inflammation and preventing further damage:
- Rest: Limited rest to avoid exacerbating the injury
- Ice therapy: Applying ice packs to the affected area for 15-20 minutes every 3-4 hours
- Pain management: Over-the-counter pain relievers such as ibuprofen or acetaminophen
Medications
Depending on the severity of symptoms, a healthcare provider may prescribe:
- Prescription-strength NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
- Muscle relaxants for severe muscle spasms
- Short-term use of opioid pain medications in severe cases
Physical Therapy
Physical therapy plays a crucial role in the recovery process for whiplash injuries. A tailored physical therapy program may include:
- Gentle stretching exercises to improve flexibility
- Strengthening exercises for the neck and upper back muscles
- Posture and ergonomic training
- Manual therapy techniques to improve joint mobility
- Heat therapy to increase blood flow and reduce muscle tension
Alternative Therapies
Some patients find relief through complementary therapies, although the scientific evidence for their effectiveness varies:
- Chiropractic care
- Acupuncture
- Massage therapy
- Mindfulness and relaxation techniques
How long does physical therapy typically last for whiplash recovery? The duration of physical therapy can vary widely depending on the severity of the injury and individual response to treatment. Many patients see improvement within 6-8 weeks, but some may require longer-term therapy.
Preventing Chronic Complications of Whiplash
While many people recover from whiplash within a few weeks to months, some individuals develop chronic pain and long-term complications. Understanding the risk factors and taking proactive measures can help prevent these issues.
Risk Factors for Chronic Whiplash
Several factors may increase the likelihood of developing chronic symptoms:
- High-intensity pain immediately following the injury
- Restricted neck movement
- Pre-existing neck or back pain
- Older age
- Female gender (possibly due to differences in neck muscle strength and structure)
- Psychological factors such as anxiety or depression
Strategies for Prevention
To minimize the risk of chronic complications, consider the following approaches:
- Early intervention and appropriate treatment
- Adherence to prescribed physical therapy and exercise programs
- Gradual return to normal activities as tolerated
- Stress management and psychological support if needed
- Regular follow-ups with healthcare providers to monitor progress
Can lifestyle modifications help in preventing chronic whiplash symptoms? Absolutely. Maintaining good posture, engaging in regular neck-strengthening exercises, and ensuring proper ergonomics at work and home can all contribute to better neck health and resilience against future injuries.
Emerging Research and Future Directions in Whiplash Treatment
As our understanding of whiplash injuries continues to evolve, researchers are exploring new avenues for diagnosis, treatment, and prevention. These advancements hold promise for improving outcomes for whiplash patients in the future.
Advanced Imaging Techniques
Researchers are investigating the use of advanced imaging technologies to better visualize and understand the soft tissue injuries associated with whiplash:
- Diffusion Tensor Imaging (DTI): A specialized MRI technique that can detect subtle changes in white matter tracts of the brain and spinal cord
- Functional MRI (fMRI): To study changes in brain activity patterns associated with chronic pain following whiplash
Biomarker Research
Scientists are exploring the potential of biomarkers – measurable indicators in blood or other bodily fluids – to:
- Diagnose whiplash injuries more accurately
- Predict which patients are at higher risk for developing chronic symptoms
- Monitor treatment effectiveness
Regenerative Medicine
Emerging therapies in regenerative medicine show promise for treating whiplash injuries:
- Platelet-Rich Plasma (PRP) injections: To promote healing of damaged ligaments and tendons
- Stem cell therapy: Potentially to regenerate damaged intervertebral discs
Virtual Reality in Rehabilitation
Virtual reality (VR) technology is being explored as a tool for:
- Pain management
- Improving range of motion through gamified exercises
- Addressing psychological aspects of chronic pain
How might these emerging treatments change the landscape of whiplash care? While many of these approaches are still in the research phase, they offer hope for more personalized and effective treatments in the future. As our understanding of the complex nature of whiplash injuries grows, so too does our ability to develop targeted interventions that address both the physical and psychological aspects of this condition.
In conclusion, whiplash remains a challenging injury to diagnose and treat effectively. However, with ongoing research and advancements in medical technology, the future looks promising for improved outcomes and quality of life for those affected by whiplash injuries. As always, early intervention, comprehensive care, and a multidisciplinary approach remain key to achieving the best possible results for patients suffering from this complex condition.
Whiplash Injury | Johns Hopkins Medicine
What is a whiplash?
Whiplash is an injury to your neck. It is caused by your neck bending forcibly forward and then backward, or vice versa. The injury, which is poorly understood, usually involves the muscles, discs, nerves, and tendons in your neck.
What causes a whiplash?
Most whiplash injuries result from a collision that includes sudden acceleration or deceleration. Many whiplash injuries occur when you are involved in a rear-end automobile collision. They also happen as a result of a sports injury, particularly during contact sports.
What are the symptoms of a whiplash?
These are the most common symptoms of whiplash:
Neck pain
Neck stiffness
Shoulder pain
Low back pain
Dizziness
Pain in your arm or hand
Numbness in your arm or hand
Ringing in your ears
Blurred vision
Concentration or memory problems
Irritability
Sleeplessness
Tiredness
The symptoms of whiplash may look like other conditions and medical problems. Always see your healthcare provider for a diagnosis.
How is a whiplash diagnosed?
Along with a complete medical history and physical exam, tests for whiplash may include the following. Many whiplash injuries include damage to soft tissue that can’t be seen on X-rays:
X-ray. Electromagnetic energy beams produce images of internal tissues, bones, and organs onto film.
Magnetic resonance imaging (MRI). Large magnets and a computer make detailed images of organs and soft tissue structures in your body.
Computed tomography (CT) scan. X-rays and computer technology make horizontal, or axial, images (often called slices) of your body. A CT scan shows detailed images of any part of your body, including your bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
How is a whiplash treated?
Your healthcare provider will determine specific treatment for whiplash, based on:
Your age, overall health, and medical history
Extent of your injury
Your tolerance for specific medicines, procedures, or therapies
Expectations for the course of your injury
Your opinion or preference
Treatment may include:
Ice applications for the first 24 hours
Cervical (neck) collar
Gentle, active movement after 24 hours
Nonsteroidal anti-inflammatory medicines (NSAIDs such as ibuprofen)
Muscle relaxing medicines
Physical therapy
Osteopathic manipulation
What are the complications of a whiplash injury?
While most people who have a whiplash injury recover within a few weeks to a few months, some have persistent pain for several months or longer.
When should I call my healthcare provider?
If your symptoms have not improved within the time frame your healthcare provider suggested, let him or her know. Also, if your symptoms get worse or you get new symptoms, tell your provider.
Key points about whiplash
Whiplash injury is poorly understood, but usually involves the muscles, discs, nerves, and tendons in your neck.
It is caused by the neck bending forcibly forward and then backward, or vice versa.
Many whiplash injuries occur if you are involved in a rear-end automobile collision.
Your healthcare provider will determine specific treatment for your whiplash.
Whiplash Injury | Cedars-Sinai
ABOUT
CAUSES
DIAGNOSIS
TREATMENT
NEXT STEPS
What is whiplash?
Whiplash is an injury to your neck.
It’s caused by your neck bending forcibly forward and then backward, or vice versa.
The
injury is not well understood. But it often affects the muscles, disks, nerves, and
tendons in your neck.
What causes whiplash?
Most whiplash injuries result from
a collision that includes sudden acceleration or deceleration. Many whiplash injuries
occur when you’re involved in a rear-end automobile collision. They also happen as
a
result of a sports injury, especially during contact sports.
What are the symptoms of whiplash?
These are the most common symptoms
of whiplash:
- Neck pain
- Neck stiffness
- Shoulder pain
- Low back pain
- Dizziness
- Pain in your arm or hand
- Numbness in your arm or hand
- Irritability
- Sleeplessness
- Tiredness
- Trouble turning your head
These symptoms may be caused by
other health problems. Always see your healthcare provider for a diagnosis.
How is whiplash diagnosed?
Along with a complete health
history and physical exam, tests for whiplash may include:
- X-ray. Electromagnetic energy beams make images of
internal tissues, bones, and organs onto film. But many whiplash injuries include
damage to soft tissue that can’t be seen on X-rays. - MRI. Large magnets and a computer make detailed images of
organs and soft tissue structures in your body. - CT scan. X-rays and computer technology make detailed
images of any part of your body, including your bones, muscles, fat, and organs. CT
scans are more detailed than general X-rays.
How is whiplash treated?
Treatment will depend on your symptoms, age, and general health. It
will also depend on how severe the condition is.
Treatment may include:
- Applying ice for the first 24
hours - Neck (cervical) collar
- Gentle, active movement after 24
hours - Nonsteroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen - Muscle relaxing medicines
- Physical therapy
- Osteopathic manipulation
- Topical gels or shots into the neck to ease pain
What are possible complications of whiplash?
Most people who have a whiplash
injury recover within a few weeks to a few months. Some people have persistent pain
for
several months or longer.
When should I call my healthcare provider?
Call your healthcare provider
if:
- Your symptoms haven’t improved in the time frame your
provider advised - Your symptoms get worse
- You have new symptoms
Key points about whiplash
- Whiplash is not well understood, but
it often affects the muscles, disks, nerves, and tendons in your neck. - It’s caused by the neck bending
forcibly forward and then backward, or vice versa. - Many whiplash injuries occur if you
are involved in a rear-end automobile collision. - Your healthcare provider will
determine specific treatment for your whiplash.
Next steps
Tips to help you get the most from
a visit to your healthcare provider:
- Know the reason for your visit and
what you want to happen. - Before your visit, write down
questions you want answered. - Bring someone with you to help you ask
questions and remember what your provider tells you. - At the visit, write down the name of a
new diagnosis, and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you. - Know why a new medicine or treatment
is prescribed, and how it will help you. Also know what the side effects are. - Ask if your condition can be treated
in other ways. - Know why a test or procedure is
recommended and what the results could mean. - Know what to expect if you do not take
the medicine or have the test or procedure. - If you have a follow-up appointment,
write down the date, time, and purpose for that visit. - Know how you can contact your provider
if you have questions.
Medical Reviewer: Joseph Campellone MD
Medical Reviewer: Marianne Fraser MSN RN
Medical Reviewer: Raymond Kent Turley BSN MSN RN
© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.
Whiplash
Car accidents are often accompanied by such a situation. The impact of the car from behind causes the passenger or driver to sharply tilt their head forward, followed by a strong throw back. A blow to the car in front, on the contrary, causes a sharp throwing of the head back and a subsequent strong tilt forward.
Both cause damage to the cervical spine called whiplash. If a passenger or driver is wearing a seat belt, the chance of a whiplash injury is greatly increased.
Car accidents are the most common cause of whiplash in the neck. But this damage can also occur during a jump into the water from a springboard or during an unsuccessful fall. What is the danger of such an injury and what does it represent?
Whiplash damages the ligaments of the spine and neck muscles. Possible damage to the intervertebral joints in the cervical region. The spinal cord and nerve roots are relatively rarely injured. But this is no reason to underestimate the situation. Swelling of soft tissues causes compression of the nerve roots and pain in the neck, neck-collar zone.
These symptoms are especially pronounced in cases where there is already cervical osteochondrosis. Hence the diagnosis of “traumatic exacerbation of osteochondrosis.” Considering that up to half of people over 35-40 years of age suffer from this disease of varying severity, whiplash is a serious case that requires treatment. After all, it can accelerate the development of the disease and even lead to an intervertebral hernia. And this is either surgery or paralysis. It is better to prevent such a scenario than to deal with it.
In addition, whiplash is often the cause of cervical artery syndrome, a complex of symptoms associated with impaired blood supply to the brain.
An artery passes through the cervical spine, which feeds the brain. Whiplash pain causes a reciprocal muscle spasm, which after a while becomes persistent. Spasmodic muscle fibers compress the artery, and blood flow to the brain worsens. There is a whole range of symptoms, including headache, impaired coordination of movements, unsteady gait, visual disturbances, decreased brain activity, memory impairment and mental performance. Jumps in blood pressure are possible.
In addition, whiplash can cause such symptoms of osteochondrosis exacerbation as numbness in the hand, muscle weakness of the hand. But in most cases it doesn’t come to that. The most common symptom of whiplash injury is pain and limited mobility in the neck, pain in the back of the head.
The most commonly used painkillers for whiplash are the ointments advertised on TV. In severe cases, they resort to injections of lidocaine – anesthetic blockades. But both the first and the second do not heal the injury, but simply let the process take its course.
Meanwhile, the danger of whiplash is not limited to the possibility of a herniated disc. It can lead to progressive destruction of the cervical intervertebral joints – spondylarthrosis. The mobility of the neck in this disease is gradually limited to the point that the person is completely unable to turn or tilt his head. Another danger is fibrosis of the vertebral ligaments in the cervical region and cervical muscles.
Hence the conclusion that whiplash must be treated. Anti-inflammatory ointments will not help with this. The help of a doctor is required. And best of all, complex oriental medicine copes with such cases. But first it is necessary to exclude serious traumatic injuries – fractures of the vertebrae, intervertebral joints, the formation of a sequestered hernia. Therefore, without an X-ray, and even better, an MRI of the cervical region is indispensable.
Once major complications have been ruled out, serious treatment can begin. Serious in this case does not mean long-term. Already several complex sessions will relieve the symptoms of trauma and minimize the risk of its complications.
The first thing the doctor will do is remove the pain and inflammation. For this, in oriental medicine, acupuncture is used, that is, the introduction of needles into certain points in the spine. This procedure relieves muscle tension. In addition, it has analgesic and anti-inflammatory effects. Due to the introduction of needles, the swelling of the soft tissues around the nerve roots decreases and then disappears. The pressure on the nerves disappears and the pain goes away.
The muscle spasm can then be completely relieved with acupressure. Further, manual therapy is used, but not always, but only in cases where cervical traction is indicated. With the help of manual techniques, the doctor reduces pressure on the intervertebral discs, reduces subluxations and displacements of the vertebrae, and releases the nerve roots.
After these three procedures, the pain in the neck, occiput and cervico-collar region disappears, swelling subsides, muscle tension disappears, and neck mobility is restored. This treatment produces positive results in almost 100% of uncomplicated cases of whiplash.
If an x-ray or MRI shows a fracture or a complex hernia, Oriental medicine can do little to help. You may need surgery or other radical treatments. In this case, oriental methods will help already at the stage of rehabilitation, for faster recovery and minimizing the risk of delayed complications.
A feature of oriental medicine for whiplash is that it accelerates and activates the natural recovery processes. It accelerates healing, improves metabolic processes in the structures of the cervical region. At the same time, it well relieves pain syndromes, inflammation and swelling, removes muscle spasms and tension. All this in combination gives very good results not only in chronic diseases of the spine, but also in traumatic injuries, such as whiplash.
Neck taping after whiplash
December 3, 2021
Whiplash is a serious injury to the cervical spine that can significantly reduce the quality of life and lead to disability. In the absence of treatment for six months, the pathology takes a chronic form. At the first sign of damage, you should immediately consult a doctor. This will provide the best chance of restoring neck mobility. Kinesiology taping will speed up recovery. You can even apply tape for neck pain yourself. However, it is important to carefully study the methodology and follow certain patterns.
Whiplash neck symptoms
Damage of this type is accompanied by the following symptoms:
- Persistent headaches. They are provoked by problems in the cervical region and are called cervicogenic. They arise as a result of damage to the upper cervical discs, disorders in the atlantoaxial, atlantooccipital, facet joints. Cervicogenic headache can develop into a migraine;
- Pain and heaviness in the arm. Most often caused by compression of the root of a herniated disc. The pain may “reflect” from other parts of the neck. Pain is not associated with nerve compression;
- Deterioration of concentration, memory impairment. In some cases, the cause is a mild concussion of the brain. These phenomena can also occur while taking painkillers. Depression, increased irritability develop;
- Back pain. Caused by damage to the discs, sacroiliac and facet joints;
- Sleep disturbance. May be caused by pain, depression;
- Violation of visual acuity, increased fatigue, tinnitus, etc.
Causes of damage
Whiplash injury of the cervical region occurs for the following reasons:
- accident. Most often, it is a strong blow in a car accident that leads to damage to the neck. In this case, seat belts do not save. They are designed to protect the body from other injuries;
- Sharp, violent blow to the head, sports injuries;
- Fall from height;
- Birth injury;
- Passion for extreme entertainment. In the case of a sharp change in the position of the head, with frequent turns of the neck, back from side to side, unpleasant complications can occur.
The cervical spine is the first to receive a negative impact on the body.
Whiplash severity
Doctors diagnose 4 degrees of severity of damage:
- I degree. Accompanied by pain and stiffness of the neck. Soft tissue damage is minor;
- II degree. Pain is accompanied by damage to muscles, ligaments, tendons. Pain is felt in the head and upper limbs;
- III degree. Injuries are accompanied by neurological disorders;
- IV degree. There are fractures and dislocations of the vertebrae. The patient needs hospitalization immediately after injury.
Whiplash Diagnosis
To determine the type of injury, the doctor conducts an examination, clarifies the circumstances of the injury, prescribes an x-ray. With the help of a picture, a specialist assesses the condition of the spine, the presence of possible fractures. If there is a suspicion of spinal cord compression or intervertebral hernia, the specialist additionally prescribes MRI, CT, myelogram.
Benefits of Kinesio Taping
Application of kinesiology tape for cervical spine injury provides the following benefits:
- The application relieves muscle tension;
- Application of kinesio tapes allows you to remove puffiness, treat tissue inflammation;
- Whiplash neck taping helps restore joint mobility;
- Metabolic processes are normalized;
- The procedure improves the conduction of nerve impulses in the brain;
- Tapes properly adhered to the skin reduce the severity of pain.
Due to the elasticity of the bands active movements are possible. With applications, you can perform therapeutic and preventive exercises.
Whiplash treatment with taping can be enhanced by other rehabilitation methods. Increases the effectiveness of manual therapy. The effect will be noticeable after a couple of hours after applying the patches. The pain completely disappears after a few days. The duration of wearing plasters for whiplash injuries can be up to 5 days.
Application
When applying tapes for injuries of the cervical spine, it is important to avoid strong tension. During the application of teips, the head is bent at a slight inclination. A decompression bandage should be created according to the scheme used for osteochondrosis, in the area of \u200b\u200bthe greatest pain. Tapes 5 cm wide can be used or lymphatic drainage applications can be created from “noodles”. To do this, the patches are cut into small fringes. Lymphatic drainage technique will avoid swelling in the damaged area.
You can learn how to properly glue tapes on the neck at online taping courses. Training is conducted on the basis of the Academy of Therapeutic Taping.
Despite the high efficiency of taping, it has limitations for its application.
Kinesiology patches are not recommended for patients with:
- elevated body temperature,
- thromboses,
- benign and malignant tumors,
- reflux disease,
- kidney diseases,
- diabetes mellitus (may cause severe modified insulin requirements), etc.
Taping is not safe in the acute phases of any disease. The patches are not sterile, so they must not be used on damaged areas of the body.
How to choose
When choosing kinesio tapes, it is important to pay attention to the following parameters:
- Material. It is recommended to use products made from natural fabrics. The best option is cotton patches with hypoallergenic glue;
- Size. Tapes are supplied in rolls 1.2-32 m long. Tape width can vary from 2.5 to 10 cm.
- Producer. Korean-made products received excellent recommendations. Japanese, European, American teips are also characterized by high quality and safety indicators;
- Colour, design. The choice of color is made solely on the basis of individual preferences. The color does not reflect the specific properties of the product. Ribbons are presented in discreet shades and bright colors, may contain prints, inscriptions, drawings.